MEDICARE: MRS. KEITHA LYNN ECKLES NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	COA#NP-01893	OH
2	363LN0005X	Critical Care Neonatal Nurse Practitioner	NCC#ECK1-0427-7390	OH

General Provider Information

NPI Number	:	1952557084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEITHA LYNN ECKLES NP

Provider Business Mailing Address
First Line	:	700 CHILDREN'S DRIVE
Second Line	:	24 NICU - NNP PROGRAM
City	:	COLUMBUS
State	:	OH
Zip	:	43205
Country	:	US
Telephone Number	:	614-722-6510
Fax Number	:	722-722-4772

Provider Business Practice Location Address
First Line	:	6001 EAST BROAD ST
Second Line	:	MOUNT CARMEL EAST HOSPITAL
City	:	COLUMBUS
State	:	OH
Zip	:	43213
Country	:	US
Telephone Number	:	614-234-6590
Fax Number	:	614-234-9395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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